AIFA, the Italian Medicines Agency, suspended the administration of the Astrazeneca vaccine for the Sars-SoV-2 virus responsible for Covid-19. Future decisions must be awaited. There remains the reality of a virus that attacks, directly and indirectly, heart and circulation and another certainty: i vaccines currently available, however, do not contain the virus. And it is a substantial difference, even when it comes to possible effects on circulation related to vaccination.
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“Both messenger RNA and viral vector vaccines, in fact, provide the information to enable the body to produce specific antibodies to the Spike protein – he explains. Paolo Bonanni, director of the Institute of Hygiene of the University of Florence. It is a surface protein, so there is no virus in the vaccinated body. Therefore, there is no biological plausibility that could correlate the vaccine with clinical manifestations, such as thrombosis, related to the actual infection. Furthermore, pending the assessments of the regulatory authorities, it must be said that these vaccines are “multidose”, that is, several people are vaccinated with one package. How come possible effects on an individual are observed only in a group of people who have received the same potential stimulus? “. In short, there is still a lot to understand. The clearer are the relationships between Sars-CoV-2 virus and circulation together. to Pasquale Perrone Filardi, Professor of Cardiology at the Federico II University of Naples and President-elect of the Italian Society of Cardiology (SIC).
What can happen to the heart in the event of Covid-19?
The coronavirus, like the influenza virus, has a specific tropism for the cells of the respiratory system, but it can nevertheless damage other organs directly or indirectly, including the heart. These damages occur mainly through the exacerbation of the inflammatory response, which, from a phenomenon of protection of our organism to foreign agents, becomes a mechanism of cellular damage also at the heart level. In addition, the heart suffers from reduced blood oxygenation caused by the infection and from increased stress with consequent activation of the sympathetic nervous system which causes an increase in heartbeat and constriction of the arteries.
The effects of infection on clotting and thrombosis risk?
The process of blood coagulation in the human body is extremely complex, but it can be generically traced back to two events: on the one hand the fibrinolysis pathway acts, which leads to ‘dissolving’ the clots, on the other there are mechanisms that lead instead to form the clot, a sort of “reticulum” of fibrin and platelets which, when it assumes pathological aspects, determines the formation of a thrombus that can obstruct our blood vessels. There is no doubt that the sars-CoV-2 virus, responsible for Covid-19, modifies this balance through the excess of the inflammatory reaction. The result is an increased risk of thrombosis and embolism. The direct activity of the virus on the internal wall of blood vessels, called the endothelium, also contributes to this outcome, with a consequent further increase in the risk of developing venous thromboembolism and arterial thrombosis which can lead to pulmonary embolism or myocardial infarction.
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Who Affects Thromboembolism?
The population at greatest risk of venous thromboembolism is made up of patients undergoing orthopedic surgery for hip or knee prosthetic replacement, cancer patients, those with particular coagulation disorders and more generally those undergoing surgery or those who are forced to a long immobility. People suffering from heart failure are also at risk. Other predisposing causes are advanced age, obesity and venous insufficiency. It is estimated that one in every 1000 people of adult age is affected by deep venous thromboembolism in one year
Are women at greater risk?
The female gender is more exposed to venous thromboembolism. More easily women suffer from classic phlebitis, which manifests itself with swelling of the leg, redness and pain. They also present some stages of life at greater risk, such as pregnancy (increases the pressure in the veins of the pelvis slows the flow of blood) and puerpuerus. The use of hormonal contraceptives to prevent osteoporosis and menopausal disorders can increase the risk of venous thrombosis. In fact, hormones can promote clotting, especially in women with coagulation disorders, facilitating the formation of a thrombus.
How does it manifest itself?
The symptomatic picture of venous thromboembolism is characterized by pain, swelling, redness of the affected area and dilation of the superficial veins, especially of the legs. The skin can also feel warm to the touch. With complications, such as pulmonary embolism, sudden shortness of breath, chest pain, and rapid heartbeat may be present.
How is it recognized?
The key examination, which should always be performed in the presence of signs and symptoms of venous thromboembolism of the legs, is venous ultrasound Doppler. It is completely harmless and is based on the passage of a probe on the surface of the leg, in correspondence with the vein that is assumed to be at risk. it allows to evaluate not only the veins but also the arteries, recording the blood flow and the possible presence of obstructions. Among the blood tests, in addition to the general picture, the role of a compound (D-dimer), derived from fibrin, which facilitates the formation of clots, appears increasingly important. In case of high values the risk of thrombus is high. However, the test may not be particularly specific, given that the value also increases in the case of infections, after a trauma or as a result of other pathologies.
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What is thrombosis?
The thrombosis is the formation of a blood clot inside a vessel, capable of blocking all or part of a vein (venous thrombosis) or an artery (arterial thrombosis). When a thrombus, which has developed in any peripheral vessel, undergoes fragmentation, the resulting thrombotic fragment (embolus) moves within the bloodstream thus being able to reach the lung, causing pulmonary embolism, an extremely serious condition. In the Western world, one person every 37 seconds dies from blood clots that obstruct the flow of blood in the deep veins or lungs (or more than 843,000 deaths each year).
How many people does pulmonary embolism affect?
According to a study conducted some time ago in two regions, Piedmont and Lombardy, the incidence of the disease in the study period in the two years of observation was 55.4 cases per 100,000 inhabitants for women and 40.6 cases per 100,000 in men, although if by correcting the numbers by age, the differences between the two sexes were reduced.
What is disseminated intravascular coagulation?
Disseminated intravascular coagulation or Cid causes the blood to coagulate spontaneously within the vessels. The situation is extremely serious given that various organs can be affected, including the “noble” ones, ie the heart, brain and kidneys, to the point of creating a potentially lethal multi-organ failure.
What is Covid-19 related thrombocytopenia?
Thrombocytopenia on an autoimmune basis, also called immune thrombocytopenic purpura (ITP), can occur as a complication of Covid-19. It mainly affects the elderly and the most serious patients and leads to a lack of platelets, with a greater risk of bleeding. In this case it occurs mainly due to the alterations that the virus produces in the body’s defensive system, altering it.
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